| NPI | 1801456223 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX T8495) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MO 2019019119) |
| Enumeration Date | 2019-06-18 |
| Last Update Date | 2022-08-05 |